Uterotonic (drug that contracts the uterus) is given as soon after birth of anterior shoulder as possible.

As soon as the uterus contracts, placenta is delivered by controlled cord traction (CCT) with counter-traction on the uterus through the abdomen.

Source Adapted from Harshad Songhvi, MNH/JHPIEGO, 2004

11Active Versus Expectant Management Clinical estimation generally thought to be underestimates by about 34-50Oxytocin, ergometrine or both IM/IVPrendiville, Elbourne, McDonald, The Cochrane Library issue 3, 2003 12Issue Requirements of Active Management of the Third Stage of Labor

There is great variation in the way providers practice even with up-to-date standards of care

Letters/memos from MOH supportive of new PPH prevention policies are very helpful

18Lessons from Targeted PPH Programs in Africa 2

Cold chain solutions differ by country

Training to competency is shorter if the norm is some form of active vs. physiologic management of the third stage of labor so training models should vary

Flexible non-dogmatic approaches are essential for clinical care as well as program elements

With scarce financial resources, it is important to link with existing systems and resources

19Take-home Messages

Postpartum Hemorrhage is the largest direct cause of maternal death

Active management of the third stage of labor

can prevent 60 of postpartum hemorrhage

can be modified to the home birth setting

Putting the spotlight on postpartum hemorrhage prevention will

Reduce anemia

Reduce emergencies

Reduce need for transfusion

Reduce maternal mortality

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